CTK Luther League Permission Form
This form is for any 6th-12th grade youth participating in Christ the King Lutheran Church events. If you have any questions, please contact Deacon Ben Remmert, Dir. of Youth and Family Ministry at benremmert@ctkelc.org.
Email address *
Full Name: *
Your answer
Current Grade *
Your answer
School Attending
Your answer
Birth Date: *
Your answer
T-Shirt Size:
Mailing Address *
Your answer
Student's Cell Number: *
Your answer
Students Email: *
Your answer
Parents Cell Phone *
Your answer
Parent(s) Email *
Your answer
Emergency Contact and Phone Number: *
Your answer
Those Authorized for Pick Up *
Your answer
Medical Insurance Company and Policy Number
Your answer
Does your youth have any Medical Conditions/Allergies we should be aware of? *
Your answer
Does your youth have any behavior/learning concerns?
Your answer
Participants Covenant- I will participate fully in all CTK events and activities, honor time commitments, and respect property, and the rights of my peers and adults leaders. I understand that failure to abide by this covenant will result in consequences; one of which includes being sent home immediately at my own expense. *
I, the individual or parent/guardian of youth, authorize a representative from Christ the King Lutheran Church to take such action as deemed necessary for the care, welfare, and health of myself/youth including giving and consent of medical treatment. I understand that I am responsible for any charges that may be incurred. *
I, the individual or parent/guardian of youth, give permission to use, publish, or disclose newsletters, and websites any photographs, videos, audios, and any other material which I or my youth may have appeared, spoken, written, or otherwise represented. *
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